Psychiatric Assessment Flashcards
What are the goals of the psychiatric assessment?
Establish rapport Establish therapeutic relationship Gather data Understand the patient as a person Develop assessment/case formulation Determine differential diagnoses Develop treatment plan
What information should you review with patient at the start of the psychiatric assessment?
Review purpose with the patient
Describe the flow of the interview
Discuss confidentiality
(Consider safety issues at outset as well)
In developing a treatment plan what should be considered?
Location of care Need for lab testing Referral for neuropsychiatric testing Psychotherapy options Psychotropic medication options Education Reassurance Follow-up plan
What should the PMHNP do to encourage patient’s desire to follow-up?
Instill hope
Reduce anxiety
Provide education
What are the components of the psychiatric interview?
Identifying data Chief complaint HPI Past medical and psychiatric illnesses Family history Current and past substance use (including allergies and medications) Social/personal history Review of physical symptoms
What are clues to a medical cause rather than a psychiatric cause of patient’s symptoms?
Later age of onset Known underlying medical condition Atypical presentation of psychiatric condition Absence of personal or family history of psychiatric condition Poor response to usual treatment Substance use or medication use Waxing and waning mental status Abnormal vital signs
What neurological disorders can cause psychiatric symptoms?
Stroke Tumor MS Dementia Meningitis/encephalitis Head injury Seizure disorder Parkinson's disease
What endocrine disorders can cause psychiatric symptoms?
Hypothyroidism/hyperthyroidism Adrenal disorder Liver disorder Vitamin deficiency Diabetes, hyperglycemia, and hypoglycemia
What substances can cause psychiatric symptoms?
Corticosteroids
Antidepressants
Drugs of abuse (use, overdose and withdrawal)
What infectious diseases can cause psychiatric symptoms?
Pneumonia
UTI
Syphilis
HIV
What cardiopulmonary conditions can cause psychiatric symptoms?
MI
Hypercarbia
Hypoxia
True or false: Patient’s chief complaint should be stated in patient’s own words and in quotes.
True
What information should be sought in patient’s history of present illness? [HINT: OLD CARTS]
Onset Location Duration Character Aggravating factors Relieving factors Timing/frequency Severity
What social/personal history should be sought from patient?
Living arrangements History of violence Marital and relationship history Education history Occupational history Legal history Military service Religion Hobbies/social activities Family of origin Trauma history
What are the main elements/categories of the Mental Status Exam?
General appearance and behavior Attitude toward the examiner Speech Mood Affect Thought content Thought process Perceptual disturbances Orientation Memory Concentration Abstraction Insight/Judgment
True or false: Patient’s own words should be used to describe their mood and their words should be in quotes.
True
Under what section of the MSE would delusions be recorded?
Thought content
Under what section of the MSE would hallucinations be recorded?
Perceptual disturbances
Under what section of the MSE would depersonalization (i.e., feeling like one is not oneself or “out-of-body”) be recorded?
Perceptual disturbances
Under what section of the MSE would derealization
(i.e., feeling like one’s environment has changed in a strange way that is difficult to describe or is “surreal”) be recorded?
Perceptual disturbances
True or false: Normal though process is linear, organized and goal-directed.
True
Rapidly moving from one thought to another, but still logically connecting thoughts is known as __________________.
Flight of idea
Divulging details not directly relevant to the subject but eventually returning to address the original subject or question is known as __________________.
Circumstantial
Responding to a questions with thoughts that are irrelevant or only related in a minor way and never returning to the original questions is known as __________________.
Tangential
Thoughts that are difficult or impossible to see connected are known as __________________.
Loose thoughts or associations
Patient’s inability to move to other topics despite attempts to change the subject is known as __________________.
Perseveration
Patient’s inability to complete a thought or stopping mid-sentence is known as __________________.
Thought blocking
New words or new combinations of several words are known as __________________.
Neologisms
Confused language with no apparent meaning is known as __________________.
Word salad
By asking patient to count backwards by sevens (“serial sevens”), the PMHNP is testing patient’s ____________________.
Concentration
By asking patient to recall three words from earlier in the the interview, the PMHNP is testing patient’s ____________________.
Recent memory
By asking patient what he/she did during the summer between high school and college, the PMHNP is testing patient’s ____________________.
Long-term memory
By asking patient to make a calculation, the PMHNP is testing patient’s ____________________.
Cognition
By asking patient to name the last few presidents, the PMHNP is testing patient’s ____________________.
Fund of knowledge
By asking patient the meaning of “people in glass houses should not throw stones, the PMHNP is testing patient’s ____________________.
Concrete vs. abstract reasoning
By asking patient about how he/she is feeling, presenting and function or about the potential causes of his/her distress, the PMHNP is testing patient’s ____________________.
Insight
By determining a patient’s capacity to make good decisions and act on them, the PMHNP is determining patient’s ____________________.
Judgment
True or false: Judgment can be be inferred by whether patient understands they are doing dangerous things.
True
When a patient is admitted to a facility short-term for psychiatric evaluation as part of a crisis response because he/she poses a serious risk of physical harm to him/herself or others in the near future it is called ____________________.
Emergency hospitalization (a.k.a. “psychiatric hold” or “psychiatric pick-up”)
When a judge orders hospital treatment for a person who meets the state’s civil commitment criteria after an emergency evaluation period it is called ____________________.
Inpatient civil commitment (a.k.a. “involuntary hospitalization”)
When a judge orders a qualifying person with symptoms of mental illness to adhere to a mental health treatment plan while living the community it is called ____________________.
Outpatient civil commitment
What is presumed competency?
All adults are presumed to be competent and capable of making their own decisions regarding medical care, including mental health treatment.
What is informed consent?
Informed consent is required for all medical care provided to persons who are competent. Until a person is declared incompetent by a judge, informed consent is required for all mental health services.
Any individual facing involuntary commitment, typically has a right to what procedural protections?
A judicial hearing with at least one mental health professional present
An independent mental health evaluation
The right to be represented by competent counsel
Right to be free from “psychiatric boarding” in hospital emergency rooms
What does the FMLA provide?
Up to 12 weeks of unpaid, job-protected leave per year while maintaining group health benefits
Which employees are required to adhere to FMLA?
All public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees
Which employees are eligible for FMLA?
Employees are eligible if they have worked for the employer for at least 12 months or 1250 hours over the past 12 months.
What reasons can be used for unpaid leave?
For the birth and care of a newborn
For placement with the employee of a child for adoption or foster care
To care for an immediate family member with a serious heart condition
To take medical leave when the employee is unable to work because of a serious health condition
True or false: The PMHNP should consider FMLA if the patient can no longer perform essential job functions to normal standards but a leave can help patient get to a point where the patient can again perform those functions.
True
True or false: If patient is permanently unable to perform their job to normal standards, the PMHNP can consider requesting that the patient be reassignment to a job that can be done, if possible, as a reasonable accommodation.
True
What types of disabilities accommodations for employees with mental health disorders seek?
Environmental modifications
Equipment/technology necessary to perform tasks
Change in job duties
Flexible management/supervision
Flexible workplace or scheduling
Additional breaks or leave when necessary
